Electrosurgery is a common procedure for dentists, doctors, and veterinarians. Electrosurgical handpieces are commercially available that will accommodate a wide variety of electrodes shapes and sizes, such as needles, blades, scalpels, balls and wire loops. Also, multi-function electrodes are available. A suction coagulator is described ill U.S. Pat. No. 5,196,007, whose contents are herein incorporated by reference. This is an instrument that call be connected to a source of electrosurgical energy and that provides the handpiece in the form of a hollow tube with an exposed tip. By connecting a suction source to the hollow tube end, blood and other liquids as well as vapors and odors at the operative field can be drawn out while simultaneously bleeding capillaries can be coagulated electrosurgically. This instrument is adapted to receive a suction hose at its rear, and it requires a special nosepiece to receive an electrical connector for supplying the active electrosurgical currents.
Clip-on suction attachments for electrosurgical pencil type handpieces are also available, but often the cost is high and/or the attachment detracts from the surgeon""s ability to manipulate the handpiece with the clip-on attachment.
The importance of using suction to capture smoke and plume generated during all electrosurgical procedure is also well known in the art. Such procedures involving tissue excision invariably result in the generation of smoke and odors. This causes several problems. Firstly, the smoke interferes with the vision of the surgeon. Secondly, the smoke can be inhaled by the patient or the surgeon. Thirdly, the odors are offensive. See, for example, U.S. Pat. No. 6,001,077, which describes a plume evacuation system employing a novel wandxe2x80x94the fitting used to capture the plume and which is attached to the Suction apparatus-xe2x80x94whose contents are herein incorporated by reference. See also the copending related application, which describes a suction attachment for a standard electrosurgical pencil type headpiece which also allows the location of suction close to the active electrode end of a conventional electrosurgical electrode and whose contents are herein incorporated by reference.
Tonsillectomy is a very common surgical procedure in children and is frequently performed together with Adenoidectomy. Tonsillectomy in adults is not infrequent. It has become apparent that the tonsils, usually in association with the adenoids in children, and the uvulopalatal area in adults, may be a cause of snoring and sleep apnea. Traditionally, the Tonsillectomy is performed under general anesthesia, in a hospital setting, by dissecting the tonsil from its bed. Postoperatively, the vital signs are monitored so that any reactionary hemorrhage is quickly recognized. The patient is nursed in the coma position until the cough reflex has recovered. Reactionary hemorrhage, occurring within the first 24 hrs. of post-surgery, is the most lethal complication. Secondary hemorrhage is due to infective slough separating from the tonsil bed and occurs about 5-10 days post-surgery.
Electrocoagulation is a frequent method being used today to achieve hemostasis. Recently, a Bipolar Suction dissector was announced to address the dissection, coagulation and suction in the Tonsillectomy procedure. See U.S. Pat. No. 5,603,712. The Bipolar Suction dissector requires a pair of arms, which are joined by a connecting plug into a forceps orientation. One arm is a tubular suction channel; the other arm is fitted with a dissecting blade. Tissue must be clasped between the two arm pole ends to achieve bipolar coagulation. This device works well to achieve electro-bipolar coagulation; however both the bipolar and bipolar forceps design is a poor dissector/cutting device.
Another surgical device which attempts to simultaneously incise and coagulate tissue is the diathermy scalpel, which utilizes low frequency electrical current and a standard electrode needle. See Akkielah et al., Journal Of Laryngology and Otology, August 1997, Pgs. 735-738. The disadvantages of this method are inadequate hemostasis and unwanted thermal tissue necrosis. The use of lasers to incise and coagulate tonsils has also been used although not satisfactorily. Surgeons are accustomed to the tactile feedback that traditional surgical scalpels provide and they are uncomfortable and reluctant to utilize a device which is held above and apart from the tissue. It is also very difficult to accurately position the laser wand and arm within the small oral cavity.
Tonsillectomy excisions have also been attempted using low frequency, high power electrosurgical devices combined with a stream of high temperature gases through the electrode and directed at the tissue, in order to form the incision and coagulate tissue. This method is problematic in that it exhibits slow excision rates and high thermal tissue necrosis. Furthermore, gas embolization has been reported following surgery with this electrosurgery gas interface.
An object of the invention is an electrosurgical electrode for removing lymphoid tissue that is capable of locating close to the operative field, i.e., the tissue being treated, a source of suction or irrigation.
A further object of the invention is a suction device for an electrosurgical handpiece that ensures that the active end from which the suction is active is located close to the operative field.
Another object of the invention is a unipolar electrosurgical electrode configured to carefully dissect the tonsil or the adenoid from its bed and capsule.
Still another object of the invention is a suction device for an electrosurgical handpiece that is capable of providing efficient smoke removal or irrigation and that is relatively inexpensive to manufacture.
Still a further object of the invention is a suction device integrated with all electrosurgical electrode specifically adapted for use in a tonsillectomy procedure.
According to one aspect of the invention, a suction/irrigation conduit is integrated into a unipolar electrode itself in such manner that the plume receiving or active suction or irrigation opening is not obstructed and is always as close as possible to the operative field. The opposite end of the conduit when used to provide suction is air-coupled to a suction source which can be the device of U.S. Pat. No. 5,196,007 which supplies the suction via the handpiece handle, or via the suction attachment described in the related copending application, and may even be a clip-on attachment. When used to provide irrigation, the opposite end of the conduit is fluid-coupled to a fluid source.
According to another aspect of the invention, the electrode is dish-shaped, preferably configured in the shape generally of a spoon, with the front end exposed to provide electrosurgical currents to the tissue. In a preferred embodiment of the invention, the electrode is configured for performing a tonsillectomy or adenoidectomy procedure in which the tonsils or adenoids of a patient are excised by means of an exposed curved wire or serrated edge to which electrosurgical voltages are applied. The suction/irrigation conduit is part of the electrode shank achieved by using a hollow tube as the shank. The suction opening is located close to the active curved wire or serrated edge. Preferably, the hollow tube is of metal of a standard size for mounting in standard electrosurgical handpieces, and the hollow tube is used to connect the curved wire or serrated edge to a cable connected to the electrosurgical apparatus.
The tonsillectomy or adenoidectomy procedure is often associated with a high level of pain and risk of bleeding in the post-operative period. The main purpose or intent in the tonsillectomy or adenoidectomy procedure using the electrosurgical electrode according to the invention is to dissect, namely, carefully and precisely cut out the tonsil or adenoids from its bed and capsule. The second most important point would be hemostasis control. The third important goal is to substantially reduce unwanted thermal tissue necrosis, by limiting the electrosurgical energy to remove only tonsillar or adenoidal tissue and prevent the electrosurgical energy from affecting the surrounding healthy tissue. A fourth important point of the procedure is to remove the smoke plume, which results from the dissection of the tonsil or adenoid. This actually accomplishes several important advantages. It visually clears the surgical sight for the surgeon. It prevents the plume from traveling to the nose and throat of the patientxe2x80x94smoke or plume is a larger problem when operating inside the oral or nasal passageways as the patient may inspire the potentially harmful smoke or plume. It draws cool air over the surgical sight. The electrode of the invention satisfies these four important aspects of the surgical procedure in a relatively simple and inexpensive manner. A further advantage is that the same suction port could easily be used to aspirate or flow water or other liquid to the tissue, to cool it down and create a moist wet setting.
The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming a part of this disclosure. For a better understanding of the invention, its operating advantages and specific objects attained by its use, reference should be had to the accompanying drawings and descriptive matter in which there are illustrated and described the preferred embodiments of the invention, like reference numerals or letters signifying the same or similar components.